Preoperative C-reactive protein and textbook outcome following pancreaticoduodenectomy for pancreatic head adenocarcinoma

Table 1 Baseline characteristics of the overall cohort and comparison according to textbook outcome status

Variable	Total (n = 100)	TO (n = 53)	Non-TO (n = 47)	P value
Age, years	65.0 (56.8-70.2)	65.0 (54.0-71.0)	65.0 (60.0-69.5)	0.525
Sex				1.000
Male	61 (61.0)	32 (60.4)	29 (61.7)
Female	39 (39.0)	21 (39.6)	18 (38.3)
BMI, kg/m2	25.9 (23.3-28.1)	26.4 (23.6-28.1)	25.1 (23.2-27.2)	0.269
ASA score				0.700
I	5 (5.0)	3 (5.7)	2 (4.3)
II	83 (83.0)	45 (84.9)	38 (80.9)
III	12 (12.0)	5 (9.4)	7 (14.9)
CA19-9, U/mL	127.1 (29.6-371.3)	103.7 (17.6-294.0)	150.6 (42.6-413.7)	0.192
Preoperative CRP, mg/L	7.3 (2.1-22.4)	3.1 (1.2-8.8)	22.2 (6.9-38.5)	< 0.001
Preoperative albumin, g/L	33.8 (28.8-39.1)	34.8 (30.4-39.9)	32.0 (25.2-38.0)	0.057
Preoperative total bilirubin, mg/dL	1.7 (0.7-3.7)	1.3 (0.6-3.4)	2.0 (0.8-4.3)	0.215
Preoperative biliary drainage				0.681
Yes	64 (64.0)	35 (66.0)	29 (61.7)
No	36 (36.0)	18 (34.0)	18 (38.3)
Pylorus-preserving PD				1.000
Yes	41 (41.0)	22 (41.5)	19 (40.4)
No	59 (59.0)	31 (58.5)	28 (59.6)
Intraoperative transfusion				0.043
Yes	42 (42.0)	17 (32.1)	25 (53.2)
No	58 (58.0)	36 (67.9)	22 (46.8)

TO: Textbook outcome; BMI: Body mass index; ASA: American Society of Anesthesiologists; CA19-9: Carbohydrate antigen 19-9; CRP: C-reactive protein; PD: Pancreaticoduodenectomy.

Table 2 Textbook outcome achievement and unmet criteria

Variable	Value
Textbook outcome achieved, n (%)	53 (53.0)
Clinically relevant POPF (grade B/C), n (%)	4 (4.0)
Bile leak (grade B/C), n (%)	8 (8.0)
Postpancreatectomy hemorrhage (grade B/C), n (%)	5 (5.0)
Severe complications (Clavien-Dindo ≥ III), n (%)	31 (31.0)
30-day readmission, n (%)	21 (21.0)
In-hospital mortality, n (%)	10 (10.0)
Length of hospital stay, days, median (IQR)
TO group	12.0 (10.0-14.0)
Non-TO group	17.0 (13.0-23.0)
P value	< 0.001

POPF: Postoperative Pancreatic Fistula; IQR: Interquartile range; TO: Textbook outcome.

Table 3 Preoperative multivariable logistic regression models for textbook outcome achievement

Variable	Primary preoperative model OR (95%CI)	P value	Bilirubin-adjusted sensitivity model OR (95%CI)	P value
Age, years	0.99 (0.94-1.05)	0.745	0.98 (0.93-1.04)	0.524
ASA class ≥ III	1.50 (0.31-7.22)	0.612	1.46 (0.30-7.09)	0.640
Preoperative biliary drainage	1.61 (0.55-4.73)	0.390	1.61 (0.52-4.98)	0.406
Preoperative CRP, log2(CRP + 1)	0.46 (0.33-0.64)	< 0.001	0.45 (0.32-0.63)	< 0.001
Preoperative albumin, g/L	1.04 (0.96-1.12)	0.383	-	-
Preoperative total bilirubin, mg/dL	-	-	0.94 (0.79-1.13)	0.518

ASA: American Society of Anesthesiologists; CRP: C-reactive protein; OR: Odds ratio; CI: Confidence interval.